Mark H Kuniholm1, Elizabeth Vásquez1, Allison A Appleton1, Lawrence Kingsley2, Frank J Palella3, Matthew Budoff4, Erin D Michos5, Ervin Fox6, Deborah Jones7, Adaora A Adimora8, Igho Ofotokun9, Gypsyamber D'souza10, Kathleen M Weber11, Phyllis C Tien12, Michael Plankey13, Anjali Sharma14, Deborah R Gustafson15. 1. Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, New York. 2. Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania. 3. Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 4. Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California. 5. Department of Medicine. 6. Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. 7. Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, Florida. 8. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 9. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. 10. Department of Epidemiology, Johns Hopkins Medical Institutions, Baltimore, Maryland. 11. Cook County Health/Hektoen Institute of Medicine, Chicago, Illinois. 12. Department of Medicine, University of California, San Francisco, and Department of Veterans Affairs, San Francisco, California. 13. Department of Medicine, Georgetown University Medical Center, Washington, DC. 14. Department of Medicine, Albert Einstein College of Medicine, Bronx. 15. Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.
Abstract
OBJECTIVE: To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN: We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS: FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS: There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION: Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
OBJECTIVE: To understand the relationship between cardiovascular disease (CVD) risk and frailty among men (MWH) and women living with HIV (WWH), or at risk for HIV. DESIGN: We considered 10-year coronary heart disease and atherosclerotic CVD risk by Framingham risk score (FRS, 2001 National Cholesterol Education Program Adult Treatment Program III) and Pooled Cohort Equations (PCE, 2013 American College of Cardiology/American Heart Association) in relation to the Fried Frailty Phenotype (FFP) in the Multicenter AIDS Cohort Study (MACS) and Women's Interagency HIV Study (WIHS). METHODS: FFP was ascertained in MACS from 2004 to 2019 and in WIHS from 2005 to 2006 and 2011-2019. FFP score at least three of five components defined frailty. Repeated measures logistic regression (both cohorts) and Cox proportional hazards regression (MACS) were performed, controlled for education, income, cholesterol medication and hepatitis C virus serostatus, and among MWH and WWH, CD4+ cell count/μl, antiretroviral therapy, and HIV viral load. RESULTS: There were 5554 participants (1265 HIV seronegative/1396 MWH; 768 seronegative/1924 WWH) included. Among men, high-risk FRS was associated with increased risk of incident frailty among seronegative [adjusted hazard ratio (aHR)) = 2.12, 95% confidence interval (CI):1.22-3.69] and MWH (aHR = 2.19, 95% CI: 1.33-3.61). Similar associations were seen with high-risk PCE and incident frailty among SN (aHR = 1.88, 95% CI: 1.48-2.39) and MWH (aHR = 1.59, 95% CI: 1.26-2.00). Among women, high-risk PCE was associated with frailty in SN [adjusted odds ratio (aOR) = 1.43, 95% CI: 1.02-2.00] and WWH (aOR = 1.36, 95% CI: 1.08-1.71); however, high-risk FRS was not (seronegative: aOR = 1.03, 95% CI: 0.30-3.49; WWH: aOR = 0.86, 95% CI: 0.23-3.20). CONCLUSION: Higher CVD risk was associated with increased frailty regardless of HIV serostatus among men and women. These findings may inform clinical practices of screening for frailty.
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